utd-990112.ppt

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  • Our authors write original content for UTD.
    In creating topics, they review all of the available information.
    我們的作者會 review 所有相關的資訊
    They include background information, relevant new studies, and practical recommendations for patient care.
    包括背景資料, 新的研究 和 實用的醫囑
    When they incorporate new studies in topics, they place the information in the context of existing knowledge
    當有新的研究寫入文章時, 作者會將相關資訊一同寫入
    So that you understand how this applies to your patients
    如此一來使用者可以了解如何應用在病人身上
    You are accessing the best information to confirm a diagnosis, formulate a treatment plan, review drug information, and stay current
    我們所提供的資料可以讓您確認診斷, 規劃治療的計劃, 查看藥物資訊 和 持續更新
  • 4055 authors
    34 deputy editors
    280 section editors
    300 peer reviewers
  • 證據等級的說明
  • 證據等級是用 UTD Grade
    用數字和英文做表
    數字代表醫囑的強度
    英文代表證據的品質
    在文中會出現的組合是 1A, 1B, 1C, 2A, 2B, 2C
    也不用特別記憶, 在文章中會有超連結連至證據等級說明的視窗
  • 所謂的 google style
    輸入關鍵字, 可以輸入病名, 藥名, 症狀, 可以輸入一個關鍵字或多個關鍵字
    病名可以縮寫, 全稱, 會做spelling check
    藥名可以輸入, 學名, brand name, 但無法做 spelling check
    症狀也會做 spelling check
    其他的功能
    證據等級會放在 Recommendations的段落裡, 而Recommendations不是每一篇都有, 若有的話會放在Reference參考書目的上一個
    藥物交互作用, 可用 (1)aspirin, (2)grape seed, (3)irresa 做示範, 一次輸一種藥名
    ECG 自我測試, 若要示範ECG test,直接輸入 ECG test, 第二, 三, 四篇結果才是 ECG test
    Calculator 試算表, 目前有81種, 要查的話, 要先輸入 Calculator 就會列出所有的試算表
    Movies 影像檔, 可用 cadiomegaly 心室肥大做示範, 輸入後選一篇就有 Movies, 列在graphic之下
  • 請從圖書館的網頁進入
  • 這題可留著自我練習
  • utd-990112.ppt

    1. 1. Answeri ng Cl i ni cal Quest i ons at t he Poi nt of Care 鄭如雅 ccheng@upt odat e. com
    2. 2. Out l i ne • About UpToDat e • Evi dence Gradi ng • How t o Search • Q & A
    3. 3. About UpToDat e You don’ t need more i nf ormat i on You need t he ri ght i nf ormat i on
    4. 4. Synt hesi zes t he medi cal l i t erat ure, i ncorporat es t he l at est evi dence, and provi des speci f i c recommendat i ons f or pat i ent care
    5. 5. Evi dence i s deri ved f rom a number of Sources • Journal s: 430+ peer revi ewed j ournal s • Dat abases: – MEDLINE, The Cochrane Dat abase, Cl i ni cal Evi dence and ACP Journal Cl ub • Gui del i nes • Cl i ni cal t ri al s – FDA, CDC, NIH • Proceedi ngs • Cl i ni cal experi ence and observat i ons Incl udi ng but not l i mi t ed
    6. 6. The edi t ori al process Leading and Evidence Based Literature and Resources UpToDate Topic Review Read ..... Analyze ..... Summarize ..... ..... Synthesize ..... ..... Expert Comments ..... ..... Expert Opinion ..... ..... Recommendations ..... ..... Grade the Evidence ..... ..... Editorial Peer Review .....
    7. 7. Qui ck Fact s about UpToDat e • Topi c revi ews • Pat i ent Inf ormat i on • Drug Inf ormat i on Wri t t en by Physi ci ans f or Physi ci ans
    8. 8. Qui ck Fact s about UpToDat e • 4, 055 worl d- renowned physi ci an aut hors ( i nt ernat i onal ) • 7, 775 cl i ni cal t opi cs i n 15 speci al t i es • 4, 619 uni que drug ent ri es i n adul t , pedi at ri cs, i nt ernat i onal , and nat ural drugs ( Lexi - Comp) • 24, 637 graphi cs • 262, 209 ref erences ( Medl i ne) • Updat ed every 4 mont hs ( March, Jul y, November)
    9. 9. Speci al t i es • Adul t and Pedi at ri c Emergency Medi ci ne { new speci al t y - November 2009} • Adul t Pri mary Care & Int ernal Medi ci ne • Cardi ovascul ar Medi ci ne • Endocri nol ogy & Di abet es • Fami l y Medi ci ne • Gast roent erol ogy & Hepat ol ogy • Hemat ol ogy • Inf ect i ous Di seases • Nephrol ogy & Hypert ensi on • Neurol ogy { new speci al t y - March 2009} • Obst et ri cs , Gynecol ogy & Women’ s Heal t h • Oncol ogy • Pedi at ri cs • Pul monary, Cri t i cal Care & Sl eep Medi ci ne • Rheumat ol ogy
    10. 10. In Devel opment • Al l ergy and Immunol ogy • Dermat ol ogy • Psychi at ry • Surgery
    11. 11. Evi dence Gradi ng
    12. 12. Evi dence Gradi ng – UTD GRADE RECOMMENDATION GRADES Grade 1 StrongRecommendation Benefitsclearlyoutweightherisks andburdens(orviceversa)for most, ifnotall, patients“Werecommend…” Grade 2 WeakerRecommendation Benefitsandrisksclosely balancedand/oruncertain“Wesuggest…” EVIDENCE GRADES Grade A HighQualityEvidence Consistentevidencefrom randomizedtrials, or overwhelmingevidenceofsome otherform Grade B ModerateQualityEvidence Evidencefromrandomizedtrials withimportantlimitations, orvery strongevidenceofsomeother form Grade C LowQualityEvidence Evidencefromobservational studies, unsystematicclinical observations, orfromrandomized
    13. 13. How t o Search
    14. 14. How t o Search • New Search – search  di spl ay resul t  out put • Ot hers – Evi dence gradi ng • RECOMMENDATIONS – Cal cul at ors – Drug i nt eract i ons – ECG Test – Movi es
    15. 15. To Access UpToDat e • Pl ease go t o l i brary homepage • Just “Accept ” t he l i cense agreement and you are brought t o t he search page, ready f or your use; wi t hi n a f ew seconds
    16. 16. How t o use UpToDat e based on a Cl i ni cal Scenari o • A 50 year ol d woman i s obese ( BMI=32) and has hypert ensi on. She has not achi eved wei ght l oss despi t e counsel i ng f or di et and l i f est yl e changes. What i s t he best medi cat i on f or pharmacol ogi c management of her obesi t y • Keyword : – obesi t y drugs
    17. 17. How t o use UpToDat e based on a Cl i ni cal Scenari o • A 58 year- ol d post menopausal woman i s experi enci ng st ress uri nary i ncont i nence t hat i s i nt erf eri ng wi t h her qual i t y of l i f e. She i s not havi ng hot f l ashes, but she has heard t hat est rogen t herapy i s very ef f ect i ve f or uri nary i ncont i nence. What advi ce do you gi ve her? • Keyword : – est rogen f or uri nary i ncont i nence i n post menopausal women
    18. 18. Q & A
    19. 19. Thank you f or your at t ent i on
    20. 20. How t o use UpToDat e based on a Cl i ni cal Scenari o • 蔡先生現年 50 歲,因發燒、嘔吐且右下腹有明顯的壓痛及反彈 痛,根據醫師的經驗判斷,蔡先生應當是罹患了盲腸炎。為求 謹慎,醫師為病患抽血與電腦斷層檢查,結果顯示病患白血球 上昇、發炎指數也升高,而斷層片也顯示盲腸附近有發炎腫脹 的現象。 • 確定了疾病問題是盲腸炎,接著就是決定要用什麼怎麼來治療 ,以目前的技術建議使用腹腔鏡手術,但費用較高,如具考量 經濟效益則可採用傳統的闌尾切除術,不過哪一種方式對病患 是最好的呢? • 案例來源 – ht t p: //servi ce. f l ysheet . com. t w: 8080/Fl ysheet EDM/epap • Keyword – appendi ci t i s adul t

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